1986 - NH Legislature passes a Mental Health Services law to provide mental health care that is within each person’s own community and directed at promoting independence.

Late 1980s - NH recognized for its leadership in providing community-setting services by the National Institute of Mental Health.

Early 1990s - availability of services begins to decrease; institutionalization begins to rise (rises 150 percent from 1989 to 2010).

2011 - U.S. Department of Justice conducts an investigation of NH’s mental health system and releases findings in April that concluded NH is violating the Americans with Disabilities Act.

2012 - The class action lawsuit is filed by six named plaintiffs against the state alleging that individuals with psychiatric disabilities were unnecessarily institutionalized or at serious risk of unnecessary institutionalization.

December 2013 - A settlement agreement is entered into by the Disabilities Rights Center, United States Department of Justice and the New Hampshire Attorney General’s Office and enhancements and expansion to community-based mental health services are planned.

Help is comingNH to get improved mental health services

01/09/14

Mandy Dube, a 24-year-old New Hampshire resident, has been in and out of hospitals and institutions since she was 11 years old as a result of bipolar disorder. But sometimes, all she really needed was someone to talk to.

A landmark settlement agreement was reached last month in New Hampshire; the state will expand its housing, treatment, crisis and employment services for the state’s approximately 10,000 individuals with serious mental illnesses.

“A lot of times I would end up in the E.R. when I just needed someone to talk to, which wasn’t an available option,” Dube said. “The only service available was going into the hospital. … It feels pretty miserable, when you don’t need to be locked up.”

The shortage of community-based resources for patients with mental disabilities hit critical mass for Dube when the Connecticut Valley Home, a group home for mentally ill adults that she was living at, closed due to lack of government funding. Its residents and staff had a month to find other arrangements.

“I desperately needed the group home at the time. It was a wonderful facility but due to lack of funding they had to close. I ended up having to go to the hospital for a while because I was in a very bad situation,” she said.

Dube was one of the six named plaintiffs who represented a class action lawsuit filed in 2012 that claimed the state was needlessly institutionalizing people with mental illnesses instead of providing adequate community-based resources. The settlement agreement was reached last month by the Disabilities Rights Center, United States Department of Justice, and the New Hampshire Attorney General’s Office.

“I want to express how pleased we are with the agreement that’s been reached,” said Amy Messer, legal director of The Disabilities Rights Center. “These are the services that really improve the quality of people’s lives. They are critical, proven methods that they eliminate and reduce hospitalization. And they are cost effective.”

Under the proposed agreement New Hampshire will expand its supported housing to include a minimum of 450 units, and add Assertive Community Treatment to serve 1,500 people. The agreement also introduces new mobile crisis services in the Concord, Manchester, and Nashua regions. According to a press release from the Disabilities Rights Center, the central components of the mental health services planned under the proposed settlement agreement include:

Assertive Community Treatment: a multidisciplinary team of professionals that are available around the clock and provide a wide range of flexible services, including case management, medication management, psychiatric services, assistance with employment and housing, substance abuse services, crisis services and other services and supports.

Supported Employment: helps individuals with disabilities find and maintain competitive employment at integrated job sites in the community, reducing the risk of institutionalization, and enabling individuals to support themselves and their families.

Mobile Crisis Teams: are able to respond to individuals in their homes and communities 24/7 and include access to new crisis apartments, where individuals experiencing a mental health crisis can stay for up to seven days, as an alternative to hospitalization.

The lawsuit was filed in February 2012 by the Disability Rights Center and the U.S. Department of Justice on behalf of six plaintiffs who were currently living in a state-run nursing facility or had cycled in and out of emergency rooms and the state hospitals. Leading up to the lawsuit, the two organizations conducted independent studies that came to the same conclusion that the state had been violating the American Disabilities Act. Last September the court issued a decision certifying the suit as a class action.

Messer was disturbed that the number of persons with mental disabilities admitted to New Hampshire hospitals jumped from 900 in 1989 to 2,300 in 2011. The state’s readmission rate also was almost twice the national average after 180 days, she said.

“I think there was a reduction of our commitment to community mental health services,” Messer said.

The agreement will now go before United States District Court Judge Steven McAuliffe for preliminary approval and a final hearing before the agreement will take full effect. A final hearing is slated for February.

“This settlement agreement continues the path of progress that began with the improvements in the budget and provides long-term stability and protection to our taxpayers,” House Speaker Terie Norelli said in a release. “I look forward to working with Gov. Hassan and Senate Pres. Morse to take the appropriate legislative actions in support of this settlement.”